Medical Coding

This Viewpoint discusses the need for existing quality and reimbursement programs to adjust their data collection and quality measurement to ensure that data reported and reimbursement provided truly reflect the patient population being treated.

This study uses administrative claims data to describe trends in use of ICD-10-CM diagnosis codes for novel coronavirus patients in January-May 2020, before and afer the April 1 release of the U07.1 code to facilitate billing for and case monitoring of COVID-19.

This study uses Medicare data to estimate mortality differences for common medical conditions (pneumonia, heart failure, chronic obstructive pulmonary disease, urinary tract infection, others) at US critical access vs non–critical access hospitals between 2007 and 2017 with vs without adjustment for discharge diagnosis counts to assess the extent to which coding practices rather than illness severity might account for observed mortality differences.

This Viewpoint argues for separation of physician performance measurement from RVU production as a means to refocus physicians away from billing toward patient-centered values that could improve patients’ experience, reduce potential harms from the overtreatment that RVUs incentivize, and improve physicians’ work life and satisfaction.

In the context of a Centers for Medicare & Medicaid Services proposal to simplify evaluation and management (E/M) documentation guidelines by 2021, this Viewpoint reviews the problems with current implementation of review-of-systems history taking in electronic health records (EHRs), including information overload, lack of follow-up of findings, clinical irrelevance to some patients and visits, and dishonesty in documentation.